title: Characterization of fetal cardiac structure and function detected by echocardiography in women with normal pregnancy and gestational diabetes mellitus.
abstract: OBJECTIVE
  To assess fetal cardiac structure and function in normal pregnancy and in the presence of gestational diabetes mellitus (GDM) using echocardiography measurements.
  
  
  METHODS
  We studied fetal cardiac structure and function in 169 uncomplicated singleton pregnancies and in 92 complicated by GDM. Maternal glycemic control was deemed adequate in 75 women and inadequate in 17. Fetal two-dimensional ultrasound, pulsed wave Doppler and tissue Doppler imaging (TDI) were used to assess cardiac walls thickness and cardiac function, both systolic [with ejection fraction (EF)] and diastolic [using early diastolic peak flow velocity (E)/late peak of diastolic velocity (A) and early diastolic peak velocity at the annulus (Ea)/late diastolic peak velocity at the annulus (Aa) ratios].
  
  
  RESULTS
  In normal pregnancies, fetal ventricular walls and interventricular septum thickness increased progressively with advancing gestation and were significantly thicker in the presence of GDM (P < 0.001) independently of maternal glycemic control. Fetal cardiac systolic function indicated by EF did not change during normal pregnancy, but was significantly increased (P < 0.001) in the presence of GDM independently of maternal glycemic control. Both pulsed wave Doppler and TDI indicators of fetal diastolic cardiac function increased during normal pregnancy, reaching a maximum at 36 to 40 weeks of gestation (P < 0.001). The presence of GDM did not affect pulsed wave Doppler indicators of diastolic function [ratio of early/late diastolic peak flow velocity (E/A ratio)], whereas TDI indices [ratio of early/late diastolic peak velocity at the annulus (Ea/Aa ratio)] were significantly lower after adjustment for gestational age and estimated fetal weight (EFW); and such changes were independent of maternal diabetic control (P < 0.001).
  
  
  CONCLUSIONS
  Fetal cardiac wall thickness, cardiac systolic and diastolic functions are affected by GDM independently of glycemic control.
authors.affiliation: Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.
authors.forename: Yunyun
authors.initials: Y
authors.lastname: Ren
authors.forename: Qiongjie
authors.initials: Q
authors.lastname: Zhou
authors.forename: Yingliu
authors.initials: Y
authors.lastname: Yan
authors.forename: Chen
authors.initials: C
authors.lastname: Chu
authors.forename: Yonghao
authors.initials: Y
authors.lastname: Gui
authors.forename: Xiaotian
authors.initials: X
authors.lastname: Li
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000187:drug effects; D002302:Cardiac Output / Q000502:physiology; D016640:Diabetes, Gestational / Q000097:blood / Q000503:physiopathology / Q000628:therapy; D003927:Diet, Diabetic; D018619:Echocardiography, Doppler, Pulsed / Q000379:methods*; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D005318:Fetal Heart / Q000000981:diagnostic imaging / Q000196:embryology / Q000502:physiology; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D011247:Pregnancy; D016216:Ultrasonography, Prenatal / Q000379:methods*
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin